RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03464
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20040716

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E-4, Healthcare Specialist, medically separated for “chronic right leg pain, due to exertional compartment syndrome,” with a disability rating of 10%.  

CI CONTENTION:  “Please consider all conditions.”  The CI’s complete submission is at Exhibit A.

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (PEB) to be unfitting for continued military service and when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is based on review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB – 20040510	VARD - 20060613	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Leg Pain...	5399-5312
8723	10%	Exertional Compartment Syndrome of the Right Leg	5399-5312	0%	Failed to Report	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Right Leg Pain.  The CI reported she was working on a railhead when she developed pain over the right shin and was diagnosed with a shin splint on 28 June 2002.  She was treated with medications and duty limitations.  On 5 August 2003, the commander noted she was unable to perform her military duties due to exercise induced compartment syndrome.  The record falls silent until the CI was entered into the Medical Evaluation Board (MEB) process.  On 18 February 2004, she was issued a permanent L3 profile for right lower extremity (RLE) exercise induced compartment syndrome.  The medical officer noted compartment syndrome results from swelling of a muscle bound by fascia (typically in the calf) in which the pressure can block blood flow.  This leads to pain, neurological loss (temporary and permanent if of long duration) and even tissue death (necrosis) if persistent and untreated.  The commander’s statement was updated on 5 March 2004 by the same individual and again recommended she be found unfit for her duties.  At the MEB examination on 27 February 2004 the CI reported due to the RLE compartment syndrome she could not perform her duties.  In the MEB narrative summary dated 30 March 2004, 4 months prior to separation, the physical examiner noted swelling of the right greater than the left lower leg.  The CI reported her leg pain began after she jumped down from a rail car onto a track on 28 June 2002.  She reported pain in the anterior portion of her right leg, associated with numbness of the top of the foot, which developed after walking 1/2 to 3/4 mile or driving long distances while pressing on the accelerator.  Surgical treatment had been discussed, but declined due to the uncertainty of the outcome.  She had reduced motion of both the ankle and knee by VA standards, but both were “considered normal.”  With repeated heel raises, she reproduced her symptoms.  No comment was made on the gait; this implies, but does not state, that the gait was normal or near normal.  

Although multiple VA Compensation and Pension (C&P) examinations were scheduled, the CI did not report for an evaluation until 14 January 2010, over 6 years after separation and well outside the 12 month window of increased probative value for rating at separation.  At that examination, she had a normal gait and an unremarkable examination including no pain with compression.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the chronic right leg pain condition at 10%, coded 5399-5312 (Group XII muscle function) and 8723 (neuralgia of the anterior tibial nerve).  The VA also used the 5399-5312 code, but rated the condition at 0% as the CI did not show for her examinations.  She was subsequently rated 10% based on the VA C&P dated 30 March 2012, almost 8 years after separation.  The CI had an essentially normal examination other than the reproduction of her symptoms after repetitive heel lifts.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the chronic right leg pain condition.  

BOARD FINDINGS:  In the matter of the chronic right leg pain condition and IAW VASRD §4.73 and §4.124a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination. 

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140704, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXXXXXX AR20160011347 (PD201403464)

I have reviewed the enclosed Department of Defense Physical Disability Board of
Review (DoD PDBR) recommendation and record of proceedings pertaining to the
subject individual. Under the authority of Title 10, United States Code, section 1554a,
I accept the Board's recommendation and hereby deny the individual's application.

This decision is final. The individual concerned, counsel (if any), and any Members of
Congress who have shown interest in this application have been notified of this decision
by mail.

BY ORDER OF THE SECRETARY OF THE ARMY:

Enclosure

CF:
( ) DoD PDBR
( ) DVA